Anxiety, Wellbeing

Health Anxiety: ‘The Worried Well’

What is Health Anxiety?

Health Anxiety is a specific form of anxiety related to worries about your own health. It is a preoccupation that we either are seriously ill, or will become seriously ill at some point in the future.

It is worth noting, as with my previous post on Anxiety, that some level or worry is normal; being cautious is a basic survival instinct, and it keeps us safe (so I am highly unlikely to walk down the dark alley alone when I can hear people arguing or fighting down there, nor am I likely to eat food that has gone past its ‘use by’ date, because I am worried about the consequences if I do). But when worry becomes chronic, and out of proportion to the situation (such as not eating the food even though it’s in date and shows no outward signs of being ‘off’, or not walking down a well-lit and empty alley in the company of friends), it can then become a problem.

So, although it is good practice to notice changes in our body and go to our doctor when something has significantly changed, people who have Health Anxiety experience this to a different level; whereby it affects their day-to-day life and functioning. It can cause significant distress for yourself and your loved ones, and can result in engaging in unhelpful behaviours (even though they may seem to help you temporarily), such as repeatedly going to the GP for reassurance (it is thought that approximately 1 in 4 GP appointments are for the “worried well”).

In a nutshell, it is truly believing that there is a threat to your health (or occasionally the health of a loved one), which then triggers an anxiety response.

How does it develop?

It is not fully known how and why Health Anxiety can develop, although there are some common theories. While there is some evidence to suggest a biological or heritable basis, some other factors that can contribute to the development of Health Anxiety.

Negative Health Experiences

This can include:

  • Having a close family member or friend experience a serious illness, or death. Whilst we know death is a certainty (as the famous idiom goes, “Nothing is certain in life except death and taxes”), it’s not usually something we think about on a daily basis. When faced with the reality of a loved one’s mortality, it can make you wonder about your own mortality. If a loved one suffered a long illness, you can associate illness with pain and death. If it was a sudden death, you may suddenly become very aware of your own vulnerabilities.
  • Having experienced a serious health issue yourself. If someone has experienced something serious, they can then become more ‘in tune’ with their bodies; which can mean you are noticing sensations in your body that you were not aware of before, that are likely completely benign.
  • Being exposed to material on the TV and internet. We have the world at our fingertips, and access to all types of information all over the world. But journalists, news outlets, ‘influencers’, and people wanting to go viral also know this. If you saw a story about how someone caught a cold and recovered in 3 days with some rest and cups of tea, you wouldn’t be interested – but a story with a sensationalist headline, a misdiagnosis, a rare disease, or a freak accident is much more likely to grab your attention (and will likely have already been shared far and wide due to the nature of social media). When you’re already worried about your health and you’re surrounded by stories of rare diseases and people being misdiagnosed and dying, you are likely to be paying attention to it and potentially internalising the worries.
  • Having a family member with Health Anxiety. We grow and develop by learning from those close to us. If you grew up observing and experiencing a family member obsessively checking for symptoms, expressing worries about being ill, and visiting the doctor, you are much more likely to develop the same coping behaviours.

Rules and Assumptions

When someone is suffering with Health Anxiety, their world is guided by ‘rules and ‘assumptions’, which are usually inflexible (lots of ‘shoulds’, ‘musts’, and ‘if … then’ statements), and are usually inaccurate; although they seem very real to the person at the time, usually as a result of their past experiences.

Some rules can include: “To be healthy, I must have no symptoms”; “I cannot move forward to a  place of health without a diagnoses”; or “Every change I feel in my body must be reported to a doctor”. Assumptions could include: “If my doctor doesn’t know what’s wrong, then it must be serious”; “If a test is ordered, that definitely means something is wrong with me”; “If I ignore a change in my body, I could die”.

Fight/Flight Response and our Increased Sensitivity

As mentioned previously, worrying and caution is essential to survival. Our inbuilt ‘alarm’ is known as our ‘Fight or Flight’ response; which is the mammalian (evolutionarily old) part of our brain giving us an automatic signal that we may be in danger – we then decide whether to fight, or to leave the situation (flight). (There is also a third component, which is ‘freeze’; where the term ‘frozen in fear’ is likely to have derived from).

In the case of Health Anxiety, our inbuilt ‘alarm’ is extra-sensitive. The sensations that most people may not notice (such as a small increase in heart rate, a slightly muscle twinge in the leg, or a brief period of pain in the head) become ‘signs’ that you are suffering from something much bigger (such as a heart attack, Deep Vein Thrombosis, or a brain tumour).

The irony here is that the longer we focus on a part of our body, the more we notice how it feels. The more we manipulate a body part to feel for lumps after feeling a twinge, we are likely to make it sore and inflamed (which can trick us into thinking a lump is there). If I were to focus on my throat right now, I will likely notice that it feels a bit dry and scratchy, so I will actively swallow. The more I focus on it, I am likely to ‘feel’ like it’s getting a big tighter, or that there is a lump there when I swallow. In reality, I would have not felt any of this had I not focussed all of my attention on my throat – and it will go away when I get back to writing this post (in case you are interested, this is exactly what happened).

When you start to worry about our health, the anxiety response that is triggered by the Fight/Flight system – which includes a release of Adrenaline – will cause the same physiological response that we would get if confronted by a danger in real life (such as a tiger in the woods), such as:

  • increased heart rate
  • increased blood pressure
  • sweaty palms
  • faster breathing
  • digestive issues

So it’s easy to see how someone can fall into a cycle of worrying they are ill, getting a physical reaction, and then worrying that theit biological response to fear is a sign that something is wrong (such as a heart attack). The cycle continues when these symptoms are then focussed on more.

It’s important to note here that Health Anxiety can be present in someone completely “healthy”, and those with ‘real’ symptoms (and by that I mean those that haven’t been caused by an anxiety response, such as increased heart rate, breathing rate etc – as I do not want to imply that what a person is feeling isn’t ‘real’ to them).

Safety Behaviours

When you are experiencing disproportionate worries about your health, you are likely to engage in ‘safety behaviours’. Safety behaviours are there to prevent harm and reduce anxiety, but these particular behaviours can actually make anxiety worse. 

Some safety behaviours can include:

  • Reassurance Seeking. This can be by going to the doctor repeatedly; requesting medical tests to rule out symptoms; requesting medical tests to rule out disorders
  • Searching the internet. This can include Googling symptoms; using online self-diagnostic tools; searching/participating in forums where people share their symptoms and try and diagnose each other
  • Obsessively monitor any changes in the body. This can include regularly monitoring for any changes in the body (more than is medically recommended); ‘scanning’ your body
  • Controlling your diet
  • Not going to the doctors at all (avoidance)

What can I do?

Relaxation and Mindfulness

One of the first things you can try is practicing relaxation exercises, which can include mindfulness exercises. These can help with the times when you are engaging in an anxiety or fight/flight response.

Firstly, notice what’s going on in your body when your health anxiety is high, and make a record of it (which will likely include the signs of an anxiety response listed earlier). When you start to feel some of the signs next time, undertake breathing/grounding exercises, or mindfulness.

On my previous post about Anxiety, I have listed some breathing and grounding exercises.

On my previous post about The Importance of Being ‘Present’, I have listed some guidance on Mindfulness.

Afterwards, notice whether these symptoms are still there? They may not be, but if they are, try again.

Postpone your worries

Postponing your worries involves creating an ‘allocated worry time’, once a day, whereby you will focus on any worries you had earlier in the day during this time.

  • Set a time, duration, and place (for example, 8pm for 15 minutes in the bedroom)
  • Before this time, record any worries you have had (you can use pen and paper, or the Notes app on your phone for example). Rate your worry on a scale of 1-100.
  • During this ‘worry time’, you can focus on these worries only. (Any others that appear during this time can be noted down for your next worry time).
  • At the end of reviewing each of your worries, rate them on a scale of 1-100.

The idea of this is that you learn to be able to put your worries to one side and not have them take over your life. Also, you’ll often see a pattern emerging of the second number you record during your worry time being lower than when you recorded the actual worry; as you see that it wasn’t as ‘pressing’ as you thought.

This can also work with postponing going to seek reassurance from your GP; if you normally go within a day or two, practice postponing seeking reassurance it for longer periods.

Challenging your thoughts.

This is where you can ask yourself: “Is This Fear or Fact?”

  • When you are feeling anxious, identify a specific ‘prediction’ – such as “If I have a pain in my head, it must be a brain tumour”.
  • Note down how anxious you feel about this prediction on a scale of 1-100
  • Identify the facts that support the prediction being true (Has this happened to you or anyone you know before? Are you already predisposed to having a brain tumour? Do you have any other symptoms that indicate that you are likely to have one?)
  • Identify the facts that don’t fit with the prediction being true (Do you have any other symptoms or is it just a headache? Have you eaten/drank anything that can give you a headache – such as caffeine? Have you been exposed to any loud noises, bumps to the head, or stress before the headache occurred?)
  • Identify the likelihood of the disaster actually occurring (What is the likelihood of it being a brain tumour when compared to a headache? Have you had this headache before and it turned out not to be a brain tumour?)
  • How awful would it be (really)? (Even if it were a brain tumour, is it definitely a death sentence? If it is cancerous, isn’t medicine a lot better than it used to be? Are all brain tumours cancerous?)
  • How would you cope (really)? (you have a 100% success rate of managing to get through stressful situations as you’re still here now – so how did you cope before? How can you apply those coping mechanisms to this situation?)
  • Make an alternative, balanced, prediction (“I am highly unlikely to have a brain tumour, because I have had this type of headache before and I was reassured it was nothing / I have no other symptoms / I have recently had caffeine / I have recently experienced a stressful event / I have recently listened to loud music on my headphones. Even if it were to be a brain tumour, science and medicine are a lot better than they used to be and tumours aren’t always a death sentence anymore / not all brain tumours are cancerous.”
  • Note down how you feel now after challenging your thought on a scale of 1-100.

These are just a few ways to help with Health Anxiety. However, if you are struggling to manage it on your own, please consider speaking to your GP or booking an appointment with a local counsellor/psychotherapist.

If you’d like to book an appointment, please get in touch via the Book an Appointment page.

Leave a Reply

Your email address will not be published. Required fields are marked *